The Hill reports that President Trump plans to declare the opioid crisis a national emergency, which will open up additional sources of funding. “So far, six states [including the FEHBAR’s state Maryland] have declared statewide emergencies for the opioid epidemic and used the declaration to help increase access to the opioid overdose reversal medication, naloxone.” More details on the federal declaration should become public next week.

On the ACA front, the American Journal of Managed Care warns that “With ACA Repeal on Hold, Return of Health Insurance Tax Worries Business Groups.” Well, it worries the FEHBlog too because this ACA tax, which Congress held in abeyance for 2017 only, slams the FEHBP. “The new report by Oliver Wyman estimates that the tax will increase premiums by 2.6% in 2018, and between 2.5% and 2.7% in later years when amounts collected are tied by law to premium trends.”  While this tax is one of the whackiest aspect of the ACA, the skinny repeal and replace bill which got shot down did not repeal it. The only ACA tax which that bill would have eliminated was the medical device tax, which even Sen. Elizabeth Warren opposes. In contrast the House bill would have eliminate or delayed all of the ACA’s multitude of taxes.  The Health Affairs blog posted the suggestions of two American Enterprise Institute scholars for a bi-partisan resolution of the health care mess.

The Wall Street Journal reports today that

Since the start of the [21st] century, it has become more dangerous to have a baby in rural America. Pregnancy-related complications are rising across the U.S., and many require specialized care. For some women, the time and distance from hospitals with the resources and specialists to handle an obstetric emergency can be fatal. The rate at which women died of pregnancy-related complications was 64% higher in rural areas than in large U.S. cities in 2015. That is a switch from 2000, when the rate in the cities was higher, according to Centers for Disease Control and Prevention data analyzed by The Wall Street Journal.

The reasons reflect shrinking resources, worsening health and social ills. Most rural hospitals don’t have high-risk pregnancy specialists who can treat sudden complications. Many don’t have cardiologists or anesthesiologists on staff. Making matters worse, rates of obesity, a major risk factor for pregnancy complications, are higher in rural than urban areas.

Many rural hospitals have eliminated labor and delivery services, creating maternity deserts where women must travel, sometimes hours, for prenatal care and to give birth.
The number of rural hospitals that offered such services fell by 15% from 2004 to 2014, the Journal found in an analysis of Centers for Medicare and Medicaid Services data. That compared with a 5% decline among urban and suburban hospitals. Driving the changes are factors including closing of medical facilities, a decline in birthrates and the difficulties of getting malpractice insurance.

There are reported cases of pregnancy-related deaths that might have been avoided if the women were closer to hospitals with a higher level of care, said William Callaghan, chief of the maternal and infant health branch at the CDC.

The maternal death rate is 2.02 per 100,000 in small towns and rural areas vs. 1.23 deaths per 100,000 in urban and suburban areas.

On the bright side, Health Care Dive tells us that

  • During its second-quarter earnings call on Tuesday, CVS Health said it plans to expand its MinuteClinic program to help people with chronic diseases.
  • CVS is extending a test program that targets diabetes patients to help them monitor glucose levels, medication adherence and lifestyle habits.
  • The company also wants to add programs to manage asthma, hypertension, high cholesterol and depression over the next two years.